We keep being urged to look at the UK to see what might happen with the Omicron variant if we don’t reinstate mask mandates, surveillance measures and restrictions on gatherings: 100,000+ cases a day, the NHS overwhelmed, a “major incident” declared in London.
But a look at the number of UK hospitalisations puts things in context: about 7500 people in hospital in total is a fraction of the near-40,000 in hospital back in January, or the 20,000+ during the first wave in April 2020. The number of patients on ventilators is below where it was in September, well before Omicron.
And that’s in the depths of a UK winter when coronavirus is at its most dangerous.
In New South Wales, where summer has belatedly arrived, the number of patients in ICU is just 39; those on ventilators just 11. In late October those numbers were tripled. Even now in Victoria 81 cases are in ICU.
Yet it’s NSW Premier Dominic Perrottet bearing the brunt of criticism for “letting it rip” — despite NSW’s 93% adult vaccination rate — and under pressure to restore COVID restrictions.
Perrottet is following the plan broadly agreed to by all governments earlier this year: once vaccination rates reached high levels, restrictions would be eased and borders reopened. Case numbers would soar, but hospitalisations and ICU admissions would rise by far less. The UK data bears out that scenario, even though the adult vaccination rate there is a little lower, at 90%. Perrottet is trusting the science.
Perhaps this moment was always going to come, but the emergence of a variant has given those who want more government enforcement the opportunity to demand a reversal of the lifting of restrictions. In particular, Perrottet’s focus on personal responsibility over mandating behaviour has riled people who’d prefer police enforcing mask mandates, QR codes and limits on gatherings.
This is another front in a very old fight. It’s one that is fought every day in public health — between those who want governments to control people’s behaviour for their own good, and those who’d prefer people to make their own decisions.
It’s driven by a paternalistic view that while I and the people I know can be trusted to do the right thing, ordinary people cannot and require enforcement.
The problem COVID presents is that at some point we will have to transition away from governments controlling our behaviour to relying on people to take responsibility for their own behaviour. We used to do that with highly infectious, and often fatal, diseases like flu.
COVID isn’t going away — it will be with us in 2022 and 2023 and beyond. For those who prefer government control, and the paternalist-minded, that transition point is always off in the future, and there’s always a reason to delay. For others, their idea of personal responsibility is distorted by decades inside the public health prism. Media personality and academic Julie Leask reacted to Perrottet’s emphasis on personal responsibility by claiming “people need help to be personally responsible. It is much easier for individuals, communities, organisations and industries if governments put in place an infrastructure of regulation, rules, and strong guidance.”
Only a public health expert would argue that “personal responsibility” must be delivered by government regulation and “strong guidance”, whatever that is.
What is evident, however, is that personal responsibility, or even a reversion to mask mandates and gathering restrictions, isn’t sustainable without the continued efficacy of vaccines. Evidence from the UK is that booster vaccinations more than halve the already much lower rate of symptoms among those with a double vaccination. In the UK you only have to wait three months for a booster and can book one as soon as two months after your second dose. In Australia we’re still forcing people to wait five months.
Primary healthcare providers and pharmacies will bear the brunt of the booster effort this time, unlike the state-run vaccination effort of a few months ago. That puts more burden on the federal government which so badly bungled its vaccination rollout, to ensure GPs and pharmacies are stocked and funded.
According to the Australian Medical Association, the volume of vaccines being administered by GPs and pharmacies has fallen dramatically and the Morrison government has cut funding to GPs delivering shots, meaning the booster program is already falling behind.
Without the federal government getting its act together and accelerating booster shots and ensuring they can be deliver en masse through primary care and pharmacies — or the states again pick up the slack — personal responsibility isn’t going to work.
When we know booster shots are so efficacious in reducing symptoms, another vaccine strollout would be an outrage.